What is perimenopause?

Perimenopause means "around menopause" and refers to the time during which your body gets the natural transition into menopause, signaling the end of their reproductive years. Perimenopause is also referred to as the menopausal transition. Perimenopause is the time when a woman's hormones begin to fluctuate, thus beginning the transition into menopause. Experts state that perimenopause can be anywhere between 2-10 years before your closing period. You've attained natural menopause when you have not had a menstrual cycle for a full 12 months, after which you've entered the postmenopausal period of your life.

Although every woman has a unique approach in handling this phase, it helps to know the basic facts. Menopause is a stage in time, but perimenopause is a lengthy transitional state. It's also sometimes known as the menopausal transition, although technically, the transition ends 12 months sooner than perimenopause
Perimenopause has many definitions, but experts generally agree that it starts with irregular menstrual cycles due to declining ovarian function, and ends a year after the last menstrual period. Perimenopause can vary greatly from one woman to the next. The typical length is three to four years, even though it can last only a month or two or stretch as long as a decade.

Some women feel overcome by hot flashes and wiped out by significant periods; many have no bothersome symptoms. Periods may end more or less suddenly for some, while others may menstruate erratically for ages. As knowledge about reproductive aging has grown, so have the options for treating some of its distressing features. Women start perimenopause at various ages. You will notice signs of progression toward menopause, such as menstrual irregularity, sometime in your 40s. However, some women notice changes as early as their mid-30s. 

See: Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial.

See: Acupuncture For Anti Aging, Menopause & ED

Perimenopause causes

During the menopausal transition, your body's estrogen and progesterone production levels rise and drop. Lots of the changes you experience during perimenopause are a result of decreasing estrogen.

Your menstrual cycles may lengthen or shorten, and you might start having menstrual cycles where your ovaries don't release an egg (ovulate). You could also encounter menopause-like symptoms, such as hot flashes, sleep issues, and vaginal dryness. Treatments are available to help alleviate these symptoms. As soon as you've gone through 12 consecutive months without a menstrual period, you have officially reached menopause, and the perimenopause period is finished.

See: Kava-Kava administration reduces anxiety in perimenopausal women.

See: Yoga for Anti Aging, ED & Menopause

Perimenopause symptoms

During the menopausal transition, some subtle -- and a few not-so-subtle -- changes in your body may occur. You might experience:

Hot flashes: The majority of women do not expect to have hot flashes before menopause. Therefore it can be a huge surprise when they appear sooner, during perimenopause. Hot flashes are the most frequently reported symptom of perimenopause. They are also a regular feature of sudden menopause due to surgery or treatment with certain medicines, such as chemotherapy drugs. Hot flashes often continue for a couple of years after menopause. In up to 10 percent of women, they persist for years beyond that. Hot flashes tend to come on quickly and may last from one to five minutes. They vary in severity from a fleeting sense of warmth into a sense of being consumed by fire" from the inside out." A significant hot flash can cause facial and upper-body flushing, sweating, chills, and sometimes confusion. Having one of them at an inconvenient time could be rather problematic. Hot flash frequency varies widely. Some women have a few in a week; others might experience ten or more in the daytime, and some at night.

Sleep problems: Hot flashes are common during perimenopause. The intensity, frequency, and length vary. About 40 percent of perimenopausal women have sleep issues. Some studies have demonstrated a connection between night sweats and disrupted sleep; others haven't. The issue is too complicated to blame hormone oscillations alone. Sleep cycles change as we age, and sleeplessness is a common age-related criticism in both genders. Sleep problems are often due to hot flashes or night sweats, but occasionally sleep becomes unpredictable even without them.

- Irregular periods: As childbirth becomes more unpredictable, the period between periods may be shorter or longer, your circulation may be mild to heavy, and you might skip some periods. For those who get a persistent change of seven days or longer in the amount of your menstrual cycle, you might be in early perimenopause. You are probably in late perimenopause for those who have a space of 60 days or more between intervals.

- Depression, or anxiety swings: The reason for the symptoms, including increased irritability and anxiety/panic disease, could be sleep disturbance associated with hot flashes.

- Bone loss: Bone loss is due to declining estrogen levels and may increase your risk of osteoporosis and bone fractures.

- Lipid profiles. Decreasing estrogen levels can lead to adverse changes in your blood glucose levels, such as an increase in low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) that leads to an increased risk of cardiovascular disease. At exactly the same time, high-density lipoprotein (HDL) cholesterol ("good" cholesterol) decreases in several women as they age. 

- Low libido: During perimenopause, sexual arousal and desire might vary. But if you'd enjoy sufficient sexual intimacy before menopause, this will probably continue through perimenopause and beyond.

Mood changes: Mood swings, irritability, or increased risk of depression may happen during perimenopause. The cause of the symptoms may be sleep disturbance associated with hot flashes. Mood changes may also be brought on by factors not related to the hormonal fluctuations of perimenopause.

Decreasing fertility: As ovulation becomes irregular, your ability to conceive decreases. However, provided that you have periods, pregnancy is still possible. If you would like to prevent pregnancy, use birth control until you've had no periods for 12 months.

- Vaginal dryness: During late perimenopause, decreasing estrogen levels can cause vaginal tissue to become drier and thinner. Vaginal dryness (which generally becomes even worse after menopause) can cause itching and irritation. It might also be a source of pain during sex, leading to decreased sexual desire at midlife. Low estrogen may also leave you vulnerable to urinary or vaginal infections. Loss of tissue tone can result in urinary incontinence.

- Uterine bleeding: With less progesterone to regulate the endometrium's development, the uterine lining may become thicker until it is shed, resulting in very heavy periods. Additionally, fibroids (benign tumors of the uterine wall) which are fueled by estrogen, may become harder.

See: Hot Flashes & High Appetite with Bisoma Acupuncture & Sasang Diet

See: Ayurvedic Herbs for Menopause

Perimenopause and estrogen

The physical changes of perimenopause are suspended in hormonal alterations, especially variations in the amount of circulating estrogen. During the peak reproductive years, the amount of estrogen inflow increases and drops fairly predictably through the menstrual cycle. Estrogen levels are largely controlled by two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates the follicles -- the fluid-filled sacs from the ovaries that contain the eggs to produce estrogen. When estrogen reaches a certain level, the brain signals the pituitary to switch off the FSH and generate a surge of LH. This, in turn, stimulates the ovary to release the egg from its follicle (ovulation). The leftover follicle produces progesterone, as well as estrogen, in preparation for pregnancy. Because these hormone levels rise, the amount of FSH and LH falls. If pregnancy does not occur, progesterone drops, puberty occurs, and the cycle starts again.

See: The effect of dietary soy supplementation compared to estrogen and placebo on menopausal symptoms: a randomized controlled trial.

See: Acupuncture for Estrogen Dominance

Natural remedies for perimenopause symptoms

How to manage perimenopause symptoms naturally

A holistic strategy with natural remedies may help women alleviate perimenopause symptoms. Many factors, including physical, emotional, genetic, environmental, or societal variables, can impact a woman's health. Holistic therapies in Ayurveda, diet, lifestyle changes, herbal medicine, and treatment modalities such as Panchakarma can provide individualized evaluation and therapeutic advice.

- Mind-body medicine like stress reduction, meditation, and yoga for mild to moderate depression, cognitive decline, and hot flashes.

- Yoga is a popular therapy for women affected by sleeplessness, mood swings, and hot flashes as a result of menopause. Studies indicate that yoga can help you sleep better and lead to a more stable mood through perimenopause. Learning yoga may also boost mindfulness and restore a calm feeling to your daily life.

- Shatavari is an adaptogen that may be used for feminine health at any given stage in a lifetime. The herb offers phytoestrogenic properties, which are improved during menopause. Ayurveda states that menopause causes Vata energies to become scattered and flow upward, resulting in such symptoms as hot flashes. This herb has a downward cooling flow, correcting this energetic imbalance.

- Saraca Indica, commonly known as asoka-tree, is another female herbal formula from the Ayurvedic tradition. It's been shown to decrease inflammation throughout the body, reducing strain on hormone maintenance. Saraca Indica also has systemic antioxidant action, reducing the incidence of cardiovascular events and demonstrating cardioprotective properties. As women who have less estrogen are more vulnerable to cardiovascular disease, it supports several facets of menopause.

- Arjuna (or Terminalia arjuna) has been used in all kinds of cardiovascular disease for at least 5,000 years in Ayurveda. After estrogen levels drop in older ladies, control of cholesterol and cholesterol metabolism become difficult to keep.

- Medicinal plants containing phytoestrogens, such as ginseng, red clover, and soy, reduce hot flashes, reduce vaginal dryness, enhance energy, and enhance moods.

- Non-phytoestrogen plants like Black Cohosh and Kava to reduce hot flashes.

- Soy: Changing your diet to include more soy products can ease your menopause symptoms. This remedy may help with hot flashes, night sweats, as well as vaginal dryness.

- Vitamin D, calcium, and other nutrient supplements to help prevent osteoporosis. A vitamin D supplement may assist in making your bones stronger. Vitamin D can boost your mood, which can assist your self-perception and stabilize your emotions.

- Bacopa to boost memory.

- Black cohosh is a popular organic remedy that women use for menopause symptoms. But there's conflicting evidence about how effective it is.

See: Shatavari Root & Powder Benefits,Uses, Side Effects

See: Ayurvedic Diet & Care For Menopause Symptoms

Risk factors & precautions

Even though menopause is a normal phase in life, it may happen earlier in some women than others. Although not necessarily conclusive, some evidence indicates that certain factors may make it more likely for you to start perimenopause in old age, including:

- Family history: Women with a family history of premature menopause may experience premature menopause themselves.

- Cancer Therapy: Treatment for cancer with chemotherapy or pelvic radiation therapy was associated with early menopause.

- Smoking: The onset of menopause occurs one or two years earlier in women who smoke than in women who do not smoke.

- Hysterectomy: A hysterectomy that removes your uterus, but not your ovaries, usually does not cause menopause. But such surgery may lead to menopause occurring earlier than average.

- Interactions: Be conscious of any possible interactions of herbal nutritional supplements before you attempt any remedy. Soy products can interact with antidepressants and artificial estrogen and might increase your risk of other health conditions. Ginseng can actually result in sleeplessness and headaches if you take a lot of it.

Should you feel the need to try natural remedies for your perimenopause symptoms, try one at a time. Do not overwhelm your body when it is already adapting to a new normal balance of hormones. Always discuss any supplements or herbal products you are considering with your physician.

See: Hair Loss Treatment For Women Facing Menopause

See: Chinese Medicine For Menstrual Health

Summary

There's some evidence that natural remedies can help with the hot flashes and night sweat symptoms of perimenopause. More research is necessary to understand which treatments are most effective. Individual evaluations and recommendations about using complementary and herbal therapies have to be created for each woman based on her symptoms and risk factors, and preferences.

See: Ayurveda herbs & treatment for sleep

See: Yoga Nidra Therapy For Sleep

References

1. Lee R. (2016). Vaginal dryness — Symptoms, causes, and remedies. mayoclinichealthsystem.org/hometown-health/speaking-of-health/vaginal-dryness-symptoms-causes-and-remedies

2. Al-Anazi, A. F., Qureshi, V. F., Javaid, K., & Qureshi, S. (2011, July–December). Preventive effects of phytoestrogens against postmenopausal osteoporosis as compared to the available therapeutic choices: An overview. Journal of Natural Science, Biology, and Medicine, 2(2), 154–163 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276006/

3. Clark, A. K., Haas, K. N., & Sivamani, R. K. (2017, May 17). Edible plants and their influence on the gut microbiome and acne. International Journal of Molecular Science, 18(5), 1070

4. Komesaroff PA, et al. (2001). Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. ncbi.nlm.nih.gov/pubmed/11428178

5. Chen, M-n., Lin, C.-c., & Liu, C.-f. (2014, December 1). Efficacy of phytoestrogens for menopausal symptoms: A meta-analysis and systematic review. Climacteric, 18(2), 260–269 http://www.tandfonline.com/doi/full/10.3109/13697137.2014.966241

6. Shams T, et al. (2010). Efficacy of black cohosh-containing preparations on menopausal symptoms: a meta-analysis. ncbi.nlm.nih.gov/pubmedhealth/PMH0030180/

7. Chiaramonte D, et al. (2017). Integrative women’s health. DOI:  dx.doi.org/10.1016/j.mcna.2017.04.010

8. Cramer H, et al. (2012). Effectiveness of yoga for menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials. DOI: doi.org/10.1155/2012/863905

9. Lethaby A, et al. (2013). Phytoestrogens for menopausal vasomotor symptoms. DOI: 10.1002/14651858.CD001395.pub4

10. Carroll DG. (2006). Nonhormonal therapies for hot flashes in menopause. ncbi.nlm.nih.gov/pubmed/16477892

11. Kohama T. (2013). Effect of low-dose French maritime pine bark extract on the climacteric syndrome in 170 perimenopausal women: A randomized, double-blind, placebo-controlled trial. ncbi.nlm.nih.gov/pubmed/23447917

12. Han HJ, et al. (2013). Effects of red ginseng extract on sleeping behaviors in human volunteers. DOI: doi.org/10.1016/j.jep.2013.07.005

13. Ivanova S, et al. (2017). Current and emerging strategies in osteoporosis management. DOI: doi.org/10.2174/1381612823666170714122714

See: Ayurvedic Home Remedies For Menopause Symptoms

See: Digestion Sleep & Hormones Link

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